Cory Douglas Carroll, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

30253 Issued in CO

Practice address

1032 Luke St 2
Fort Collins, CO 80524-4037

Phone

(970) 221-5858

Fax

(970) 484-7191

NPI assigned

Aug 12, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2016 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northern Colorado Hospitalists Professional LLC

  • Hospitalist Physician
  • Fort Collins, CO
  • NPI 1831315662
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438646400000",
    "number": "1427060276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1032 LUKE ST 2",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244037",
            "telephone_number": "970-221-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 LUKE ST 2",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244037",
            "telephone_number": "970-221-5858",
            "fax_number": "970-484-7191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "CORY",
        "middle_name": "DOUGLAS",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2015-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "30253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01302538",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Carr
• Maureen Carrigan
• Monae Breonna Carrillo
• Elizabeth Carrington
• Ashley Carroll, , LPCC, LAC
• Robert Carroll, RMT
• Ryan Carroll, PA-C
• Ruth Carrothers, BA
• Aaron Scott Carson, MD
• Jana Marie Carson

• Family Medicine Physician in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.